X-Message-Number: 2329
Date: 07 Jul 93 03:03:11 EDT
From: "Steven B. Harris" <>
Subject: CRYONICS: The Wrong Stuff
Dear Cryonet:
I too, like so many people, have been following the
bleach/perfusate incident in various ways, and have considered
all of the various postings and articles. This incident is a
long way from being over, but I do want to say a couple of things
now, since some very strange things have been said so far, and
some corrections and clarifications are needed.
First, this is, of course, a serious matter. Hypochlorite is
toxic stuff, and is extremely damaging to tissues. I am quite
sure that it is damaging to tissues in concentrations much
smaller than 0.1 meq/liter, so at this point the finding of
lithium concentrations below this value do not rule out the
occurrence of a big problem. Tests for blood lithium were
developed to monitor lithium administration to manic depressive
people, not monitor hypochlorite administration to suspension
patients, and the lithium test is no more sensitive than it needs
to be for its clinical use. Since hypochlorite is a lot more
toxic than lithium, it ought to be obvious that we labor under a
limitation here trying to make one test do completely for the
other. Thus, I'm happy the blood levels were below the
relatively crude cut-off for standard clinical conditions as
regards lithium, but this is NOT enough to clear up the hypo-
chlorite issue.
Second, Hugh Hixon's reported finding that perfusate
neutralizes hypochlorite within ten seconds does not clear up the
issue, either. At minimum we need more information, which I
assume is forthcoming. Hypochlorite is an oxidant which, in the
presence of acid (for instance, in an acidic ischemic patient at
the beginning of perfusion) would be expected to disproportionate
into chloride and free chlorine, the last of which is also nasty
stuff. Presumably, some or all of this might be prevented by
reductants (such as reduced glutathione) in the perfusate, but we
need to know how Hugh made the determination that this is
happening. At what pH was this done, and how do we know this was
the pH of the patient? Did Hugh do the neutralization
measurement at near ice temps? If actual crystals of hypo-
chlorite penetrated the circuit, does it not follow that crystals
may have been perfused? How does perfusate do vs. undissolved
crystals of hypochlorite at ice temps? Since 10 seconds is also
on the order of the circulation time from heat exchanger to
brain, how can we be confident that no crystals reached the
brain? There are so many questions remaining that it is prema-
ture (to say the least) to call Mike Darwin's (or anyone else's)
concerns in this matter overblown.
To put it simply: it seems still possible that was significant
damage to this patient. Enough hypochlorite got into the patient
to turn his blood dark, remember, which means that much
hemoglobin (at the very least) was oxidized by the bleach. We
hope this all happened in the vicinity of the heat exchanger, but
we still do not yet know for sure. To really begin to have some
confidence that damage was done entirely to blood heme proteins
and not brain heme proteins, we need to do a more sensitive
lithium test, and then subject an experimental animal to similar
conditions, and similar concentrations of lithium hypochlorite
during an ice temp perfusion (such as a canine total body
washout). If we can recover the animal alive after that, we can
rest easy. If we cannot, at least we will know that brain damage
has been done.
I realize, of course, that the suggestion of animal research
at this point is a politically sensitive one, since it appears
that with the loss of Mike, Jerry, and a few other technical
people from the Alcor advisory staff that Alcor has now lost the
ability to recover live animals from a cold perfusion. In fact,
if the last patient is any index, Alcor has now lost even the
ability to do routine blood gas measurements during perfusions.
In this context, it is a little chilling (forgive me) to be
reading discussion on the net about whether or not Alcor can do
perfusions without Mike Darwin. Of course they can. If the
truth were told, just about anyone with an embalming pump, a lot
of ice, and some guts can do a cryonic perfusion. In fact, if
you do a bad perfusion, the results look pretty much the same as
a good one, and the fewer tests you do, the less difference there
is.
It's depressing as Hell, but I think there may be a sort of
Gresham's Law of Cryonics: bad suspensions drive out good ones.
They're certainly cheaper and easier and less stressful to all
involved. Furthermore, the differences are not always readily
apparent (in the future, folks, if you add half a pound of the
wrong chemical, the blood won't always turn color to warn you).
At this point, with the loss of Mike and Jerry and basic research
capability, I'm afraid that Alcor is not only at the point where
it cannot tell if it is doing good suspensions or not, but it is
at a point where it is now unable even to approach the problem of
how to tell one from the other.
It's a long way back from there.
Steve Harris
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